Precordial thump efficacy in termination of induced ventricular arrhythmias.
BACKGROUND
Reports about the efficacy of precordial thump (PT) in the termination of ventricular arrhythmias (VA) vary widely. Very little recent data about the mechanical termination of VA induced during programmed ventricular stimulation are available.


METHODS
We prospectively studied 485 consecutive patients (May 2001 to December 2007) who underwent electrophysiology study with programmed ventricular stimulation as part of their assessment for primary or secondary prevention of sudden cardiac death. In cases of induction of sustained non-tolerated VA, one of two experienced cardiologists applied a precordial thump for termination of these arrhythmias immediately after the onset of unconsciousness. When PT was ineffective, the arrhythmia was terminated by electrical cardioversion. Tolerated VA was terminated by antitachycardic pacing.


RESULTS
Sustained VA was induced in 237 patients. In 82 patients with tolerated VA, overdriving was used successfully. Sustained induced VA was not tolerated in 155 patients (mean age 64 years (32-82), 133 males and 22 females, 126 patients with coronary artery disease, left ventricular ejection fraction 30+/-11%). Mean RR interval of induced VA was 226+/-47ms. Mean time to termination of arrhythmia (by PT or DC shock) was 26s (12-280s). PT terminated VA (polymorphic ventricular tachycardia) in only two patients; in 153 patients (98.7%), PT was ineffective. We did not observe any complication of PT application.


CONCLUSIONS
Efficacy of PT in termination of induced non-tolerated VA is very low even with early application after VA onset.
Haman
Ludek
L
1st Department of Internal Medicine, University Hospital, Hradec Kralove, Czech Republic. haman@fnhk.cz
Parizek
Petr
P
Vojacek
Jan
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010812:Physical Stimulation / Q000379:methods*; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000628:therapy*